< Billing codes

Billing code

Z499A — Absence Of Signs Or Symptoms, Family History Associated With An Increased Risk Of Malignancy, In Accordance With Current Ontario Generally Accepted Clinical Practice Guidelines Sigmoid To Descending Colon

Family-history screening colonoscopy

Bill for colonoscopy in a patient without symptoms whose family history raises colorectal cancer risk under Ontario guidelines.

Watch for: Insured only when the patient's age matches current Ontario guidelines, and only one colonoscopy code per patient per day.

Code

Z499A

Description

Absence Of Signs Or Symptoms, Family History Associated With An Increased Risk Of Malignancy, In Accordance With Current Ontario Generally Accepted Clinical Practice Guidelines Sigmoid To Descending Colon

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Colonoscopy screening for a patient with no symptoms but a family history that raises colorectal cancer risk, per Ontario guidelines.

What it covers

Z499 is a colonoscopy for a patient with no signs or symptoms and a family history associated with an increased risk of malignancy, in line with current Ontario guidelines (S16).

A follow-up colonoscopy after a normal Z499 is billed as Z492 (S16).

Billing rules

• Only insured when the patient's age matches current Ontario generally accepted clinical practice guidelines (S16).
• Only one of Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 is payable per patient per day, and sigmoidoscopy Z580 is not payable with it the same day (S15, S17).
• The fee covers sigmoid to descending colon; add E740 (splenic flexure), E741 (hepatic flexure), E747 (cecum) or E705 (terminal ileum) for the extent reached. Fulguration is included (S18, S19).
• Add E749 when done in a private office; not payable in a hospital or ICHSC (S18, S19).
• Anaesthesia is billed as E032C (4 basic units plus time units); E003C is not payable, and GP97 time and extra units aren't payable on the colonoscopy C-suffix code (GP100, S18).
• Colonoscopy for chronic constipation is only insured for patients 50 or older, with a family history of increased cancer risk, or with alarm features (S18).
• Same-day assessment by Internal Medicine or Gastroenterology: see A120 (A104, S19). A pre-colonoscopy consultation is only payable if the chart shows it was medically necessary (GP18).

Often billed with

• E740, E741, E747 or E705 for extent beyond the descending colon (S18).
• Polypectomy Z571, Z518, Z517 or Z516 by size of the largest polyp, plus E720, E520, E519 or E518 for up to 2 more polyps per day; polyps under 3 mm aren't payable (S19).
• E749 when done in a private office (S18).
• E785 for IBD surveillance biopsies with diagnostic code 555, 556 or 576 and the required technique (S18, S19).

Related codes: Z492, Z555, Z497, Z496, Z580, E747, E749, A120

Source: Schedule of Benefits (July 1, 2026), Digestive System Surgical Procedures, Intestines (Except Rectum), Colonoscopy, page S16.

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